Issues related to passive smoking have recently been addressed in the specialty literature, and they are particularly relevant from two perspectives: the effects on health and implications in the initiation of smoking among youth. The mechanisms by which tobacco smoke is involved in the pathology of heart disease are numerous, and are based not on a single action, but involve multiple factors. The effects of "second-hand" smoking on the cardiovascular system are evident in cardiovascular disease biomarkers seen in nonsmokers and the increased risk of mortality. In 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control (FCTC), which was negotiated under the auspices of the World Health Organization (WHO) and is an evidence-based treaty promulgated with the intent of implementing effective policies for tobacco control. The effects of such policies have been documented in numerous studies. For example, the number of ER patients presenting with acute coronary events (myocardial infarction) has decreased 27-40 % in the U.S., 13 % in Italy, and 17 % in Scotland. The harmful consequences of passive smoking in cardiovascular and other organ systems must be confronted across the medical community. Cardiologists should unite with other specialists to encourage concerted legal action, economic measures, and public education as we work toward the tobacco endgame.